If the Republican plan to replace the Affordable Care Act becomes law, nearly 117,000 fewer Mainers would have health insurance by 2026, according to an analysis released Thursday.

The Center for American Progress, a left-leaning public policy think tank, conducted a state-by-state estimate of coverage losses based on the report issued Wednesday by the nonpartisan Congressional Budget Office that projects the American Health Care Act would leave 23 million more Americans uninsured in 2026 than would be the case under the ACA. Some of the losses would be incurred by people choosing not to purchase health insurance because the ACA’s requirement to buy insurance would be eliminated, the CBO report said.

The replacement plan is now before the Senate, where it faces an uncertain future. Republican Sen. Susan Collins of Maine, a key vote in a closely divided Senate, criticized the AHCA when the CBO report came out Wednesday. Collins, along with Sen. Bill Cassidy, R-Louisiana, has introduced a much more moderate bill that’s pending in the Senate.

“The impact (of the AHCA) would disproportionately affect older, low-income Americans. In addition, for a 64-year-old with an income of $26,500, the out-of-pocket premium cost could soar from $1,700 to as high as $16,100, an 850 percent increase,” Collins said in a written statement.

Many people would be priced out of health insurance, according to the CBO analysis, especially in the 50-64 age group, because the bill would permit insurers to charge older people up to five times more in premiums.

The 116,700 fewer people with health insurance in Maine far exceeds the 80,000 who have purchased insurance through the ACA’s individual marketplace.

There would be 57,300 fewer Medicaid recipients, 47,500 fewer people on the individual marketplace and 11,900 fewer with employer-based coverage by 2026, the center’s analysis found. The combined total of 116,700 represents slightly less than 10 percent of the state’s population.

“Those are pretty bleak numbers,” said Steve Butterfield, policy director for Consumers for Affordable Health Care, an Augusta-based health advocacy group. “These are people who now have coverage and will lose it. Pick any element of the health care system and this blows a hole right through it.”

Rep. Chellie Pingree, D-1st District, who voted against the bill, said the projections illustrate “how dramatically bad it would be” in Maine under the American Health Care Act, because Maine has an older, sicker population that would be at risk of losing insurance coverage.

Although the Center for American Progress has a liberal stance, other think tanks and organizations regarded as more moderate, such as the Kaiser Family Foundation, often have reached similar conclusions on the impact of Republican ACA replacement plans. Wednesday’s CBO report hewed closely to the Center for American Progress’ earlier projections that not nearly enough money was devoted to high-risk pools in an effort to lower the uninsured rates, and that the law would weaken protections for pre-existing conditions.

A spokesman for Rep. Bruce Poliquin, R-2nd District, declined Thursday to directly respond to the CBO score on the health bill or to estimates that millions of people, including tens of thousands in Maine, would lose coverage. Poliquin voted for the bill when it passed the House on May 4.

Instead, Brendan Conley said in a written statement that Poliquin is “committed to keeping his promise to his constituents by working with Democrats and Republicans to fix the failing health care law. He looks forward to the Senate’s review of the legislation and will continue to work on further improvements to the bill.

“Mainers’ premiums and deductibles are skyrocketing, insurers are considering pulling out of the individual market in Maine, and families have fewer and fewer health care options,” Conley said. “Simply put: Obamacare is failing, impacting tens of thousands of Maine families. We must fix the problem.”

Since the ACA’s marketplaces went into effect in 2013, the uninsured rate nationally has declined from 18 percent in 2013 to 10.9 percent in 2016, according to Gallup polling. About 20 million have insurance through the Affordable Care Act.

Employer-based coverage would fall under the AHCA because the penalty for large employers that don’t offer insurance would be removed, and the bill also would weaken “essential health benefits” that currently must be included in every plan.

A major part of the health coverage losses would be the $880 billion in Medicaid cutbacks over a 10-year period. About 75 percent of Mainers who have Medicaid coverage under the state’s MaineCare program are children, low-income seniors who qualify for both Medicaid and Medicare, and the disabled.

“This would be a substantial reduction in Medicaid funds, and it’s unlikely states would be able to make up the gap,” said MaryBeth Musumeci, associate director for the program on Medicaid and the uninsured at the Kaiser Family Foundation. “You would be left cutting optional programs.”

Some of the optional programs under Medicaid include group home services for adults with intellectual disabilities, and seniors who receive both Medicaid and Medicare.

Maine has rejected Medicaid expansion several times because Gov. Paul LePage has vetoed attempts by the Legislature to do so, but Medicaid expansion is on the ballot in November.

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